Student Life - British Society of Oral Medicine (poster presentation)

Right side of the patient's tongue showing the oral portion of the lymphovascular malformation as well as a previous surgical scar in the centre.

Introduction

The British Society of Oral Medicine (BSOM) held their winter meeting at Guy's Hospital recently and I was kindly invited to present a case that I had been involved with on our Oral Medicine clinics.

The case

This lady came to the oral medicine department of the Royal London Hospital complaining of worsening dysphagia. Understandably she was very alarmed by this and it seemed that she had been to multiple places previously trying to get this problem sorted. Upon examination it quickly became apparent what the probable cause of her discomfort was: As you will see from the poster the patient presented with an extensive lymphovascular malformation affecting the oral cavity and extending from the oropharynx up into the nasopharynx, and down into the hypopharynx.

The real problem here was how to manage a case like this without killing the patient. Any surgical resection carried huge risks due to the potential for catastrophic bleeding. However, the lesion was very extensive and unlikely to be successfully managed with embolisation of blood vessels or local sclerotherapy alone.

So what to do?!

The team deliberated at great length and discussed all the options thoroughly with the patient. Ultimately the decision was taken to utilise a staged approach. Local sclerosing agents were to be injected into the lesions aided by ultrasound guidance. Some of the feeder vessels for the lesion would then be embolised by the interventional radiology team. These methods were designed to reduce the blood supply of the lesions and shrink their size. Finally, selective surgical resection of the the most troublesome areas would be carefully performed under general anaesthetic to decompress the airway. A very complex case indeed!